Parathyroid Tumor

Cancer occurs when cells in the body become abnormal and start to multiply without control or order. These cells form a growth of tissue, called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous). A parathyroid tumor begins in one of four small glands, called the parathyroid glands. These glands are located in the neck near the thyroid gland and are part of the endocrine system. The endocrine system regulates the hormones in the body.

Like all parts of the endocrine system, the parathyroid glands play an important role in the body. These glands make parathyroid hormone (PTH), which regulates the levels of calcium and phosphorus in the blood. When a parathyroid tumor occurs, whether it is benign or malignant, it can cause significant effect.

Symptoms

A person with a parathyroid tumor may experience the following symptoms. Sometimes, a person with a parathyroid tumor does not show any of these symptoms. The doctor may diagnose a problem if a blood test shows an increased level of calcium in the blood. Or, these symptoms may be similar to symptoms of other medical conditions. If you are concerned about a symptom on this list, please talk with your doctor.

• Bone pain
• Kidney problems, including pain in the upper back and excessive urination
• Stomach pain and history of gastro duodenal ulcers
• Weak muscles
• Difficulty speaking
• Vomiting
• Depression
• Fatigue
• Confusion
• A lump in the neck

Diagnosis

In addition to a physical examination, the following tests may be used to diagnose a parathyroid tumor:

Laboratory tests. Many blood or urine tests may be done; however, the most common test is a serum calcium test. Elevated serum calcium levels can indicate the presence of a parathyroid tumor or hyperplasia (over-active cells) on one or more glands. Another common laboratory test is the parathyroid hormone (PTH) test, which looks for elevated levels of this hormone, and tests for phosphorus levels in the blood. Doctors may suspect parathyroid cancer if these blood tests find a very high level of calcium and or PTH.

Sestamibi scan. A sestamibi scan may be ordered if laboratory tests show an elevated level of PTH. A sestamibi scan is a procedure in which a protein, called sestamibi, is laced with a radioactive agent and is injected into the patient's vein. A parathyroid tumor will attract the agent, and the tumor will be visible on an x-ray of the neck.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. Tumors generate different echoes of the sound waves than normal tissue does, so when the waves are bounced back to a computer and changed into images, the doctor can locate masses inside the body.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the patient's body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan is rarely used to find a parathyroid tumor.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body.

Treatment

The treatment of parathyroid cancer depends on the size and location of the tumor, whether the cancer has spread, and the person's overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.

Surgery

Surgery is the main treatment for a parathyroid tumor, regardless of if the tumor is benign or cancerous. This type of surgery is called a parathyroidectomy. Rarely, a parathyroid cancer requires surgical removal of the affected gland and surrounding tissues. The goal of surgery is to remove the abnormal gland(s) and preserve or re-implant normal glands to keep the parathyroid gland functioning as normally as possible.

Radiation therapy

Occasionally, radiation therapy may be recommended to treat parathyroid cancer after surgery. Radiation therapy may help reduce the risks of parathyroid cancer recurring in the neck, but it is difficult to prove whether this treatment is beneficial because this type of cancer is so rare. In radiation therapy, high-energy x-rays are directed at the site of the tumor to kill cancer cells. Side effects of radiation therapy include mild skin problems, nausea, vomiting, diarrhea, and fatigue. These side effects usually go away a few weeks after treatment ends.

Medication

Medications to reduce calcium levels in the blood may be given to you by your doctor. These drugs can include calcitonin (Calcimar, Cibacalcin, Miacalcin), plicamycin (Mithramycin), gallium nitrate (Ganite), bisphosphonates (Aredia, Bonefos, Loron), or zoledronic acid (Zometa). Most of these drugs are only used for short periods of time until other therapy can be started.

Side Effects of Cancer and Cancer Treatment

Cancer and cancer treatment can cause a variety of side effects; some are easily controlled and others require specialized care. Below are some of the side effects that are more common to parathyroid cancer and its treatments.

Diarrhea. Diarrhea is frequent, loose, or watery bowel movements. It is a common side effect of certain chemotherapy or radiation therapy to the pelvis, such as in women with uterine, cervical, or ovarian cancers. It can also be caused by certain tumors, such as pancreatic cancer.

Fatigue (tiredness). Fatigue is extreme exhaustion or tiredness and is the most common problem patients with cancer experience. More than half of patients experience fatigue during chemotherapy or radiation therapy, and up to 70% of patients with advanced cancer experience fatigue. Patients who feel fatigue often say that even a small effort, such as walking across a room, can seem like too much. Fatigue can seriously affect family and other daily activities, can make patients avoid or skip cancer treatments, and may even affect the will to live.

Hair loss (alopecia). A potential side effect of radiation therapy and chemotherapy is hair loss. Radiation therapy and chemotherapy cause hair loss by damaging the hair follicles responsible for hair growth. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area. The hair may fall out entirely, gradually, or in sections. In some cases, the hair will simply thin-sometimes unnoticeably-and may become duller and dryer. Losing one's hair can be a psychologically and emotionally challenging experience and can affect a patient's self-image and quality of life. However, the hair loss is usually temporary, and the hair often grows back.

Hypercalcemia. Hypercalcemia is an unusually high level of calcium in the blood. Hypercalcemia can be life threatening and is the most common metabolic disorder associated with cancer, occurring in 10% to 20% of patients with cancer. While most of the calcium in the body is stored in the bones, about 1% of the body's calcium circulates in the bloodstream. Calcium is important for many bodily functions, including bone formation, muscle contractions, and nerve and brain function. Patients with hypercalcemia may experience loss of appetite, nausea and/or vomiting; constipation and abdominal pain; increased thirst and frequent urination; fatigue, weakness, and muscle pain; changes in mental status, including confusion, disorientation, and difficulty thinking; and headaches. Severe hypercalcemia can be associated with kidney stones, irregular heartbeat or heart attack, and eventually loss of consciousness and coma.

Infection. An infection occurs when harmful bacteria, viruses, or fungi (such as yeast) invade the body and the immune system is not able to destroy them quickly enough. Patients with cancer are more likely to develop infections because both cancer and cancer treatments (particularly chemotherapy and radiation therapy to the bones or extensive areas of the body) can weaken the immune system. Symptoms of infection include fever (temperature of 100.5°F or higher); chills or sweating; sore throat or sores in the mouth; abdominal pain; pain or burning when urinating or frequent urination; diarrhea or sores around the anus; cough or breathlessness; redness, swelling, or pain, particularly around a cut or wound; and unusual vaginal discharge or itching.

Mouth sores (mucositis). Mucositis is an inflammation of the inside of the mouth and throat, leading to painful ulcers and mouth sores. It occurs in up to 40% of patients receiving chemotherapy treatments. Mucositis can be caused by chemotherapy directly, the reduced immunity brought on by chemotherapy, or radiation treatment to the head and neck area.

Nausea and vomiting. Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. It is a natural way for the body to rid itself of harmful substances. Nausea is the urge to vomit. Nausea and vomiting are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable but cause no serious problems. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression, and avoidance of chemotherapy.

After Treatment

After treatment for parathyroid cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. This may include monitoring of your blood's PTH and calcium levels.

People recovering from parathyroid cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level.

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